The Different Therapeutic Choices with ARBs. Which One to Give? When? Why? (Blood Pressure Meds)

Am J Cardiovasc Drugs ^ | 2016 Mar 3 | Csaba András Dézsi

[ConservativeMind]

The renin–angiotensin–aldosterone system plays an important role in the pathophysiology of hypertension and is closely related with cardio- and cerebrovascular events and chronic kidney diseases. Each angiotensin receptor blocker (ARB) is important in the treatment of hypertension, according to the results of recent years. This is a practical review of the available evidence on the different benefits of ARBs beyond their blood pressure-lowering effect, with an emphasis on the differences found between the particular compounds and the therapeutic implications of the findings, with specific reference to the co-morbidities.

Introduction

The appearance of angiotensin receptor blockers (ARBs) amongst the therapeutic options in the treatment of cardiovascular diseases (CVDs) was a new milestone in the history of hypertension treatment. It further widened the range of possibilities for personalized therapy, especially for patients who cannot tolerate the use of angiotensin converting enzyme inhibitors (ACEIs). ARBs have shown excellent efficacy, they have no negative metabolic effects and they cause no accumulation of bradykinin. They also have an ability to activate the angiotensin II type 2 (AT2) receptors, which causes vasodilatation in the small vessels and presumably leads to additional cardiac and renal protection.

There is a vast amount of literature on antihypertensive and cardiovascular (CV) therapeutic choices, and recommendations are available as to when a renin-angiotensin-aldosterone system (RAAS) inhibitor should be the first drug of choice. According to the latest international guidelines, ACEIs or ARBs should be preferred in patients with co-morbid microalbuminuria, renal dysfunction and chronic kidney disease (CKD), metabolic syndrome and diabetes mellitus (DM), atherosclerosis, chronic stable angina and previous myocardial infarction (MI), atrial fibrillation (AF) as well as heart failure (HF) [1–3].

...Nevertheless, several studies are available where certain ARBs have shown additional beneficial effect; the present review of the available evidence should provide help in treatment selection for individual patients.

[ConservativeMind]

In sum, the latest class of blood pressure drugs not only has fewer side effects than ACE Inhibitors do, but they can actually benefit other conditions, depending on which one you take.

If you are on any other blood pressure medicine and have any side effects, or if you think you’ve just gotten used to the side effects, perhaps you should look into these generics as an alternative.

You might wind up even healthier than you thought you could be from a blood pressure medicine.

Please be sure to scroll through the windows with tables.

[ConservativeMind]

Oh, and “telmisartan” looks like a generally good generic option, but several other do, too.

GoodRX has these at excellent prices, if you insurance doesn’t provide as much of a discount.

[Skybird]

Good information.

[The_Media_never_lie]

Thank you for posting this.

[Covenantor]

Big thank you for posting this.

Something to discuss with my cardiologist on my next visit.

[ConservativeMind]

If an ARB is not enough by itself, it appears to be most efficacious with a Calcium Channel Blocker (CCB). From what I’ve read, diuretics or other renin influencing drugs are either less effective or create added side effects. So, don’t combine an ARB with a ACE Inhibitor or other renin acting drug.

Of course, you need to inform your doctor of these issues if they didn’t already know.

[varina davis]

save

[ConservativeMind]

Blood pressure study ping.